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Hellesdon Hospital Case Study

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Hellesdon Hospital Case Study

  1. 1. HELLESDON HOSPITAL CASE STUDY The hospital was put under special measures due to poor clinical outcomes and the NHS Regulator Monitor stepped in in February 2015. In February 2015 the Care Quality Commission (CQC) expressed serious including concerns about safety, staffing levels and leadership. Below is a draft investigation, in the form of a timeline, of what went wrong in the NHS trust. The source of this information is news reports from the internet. • May–Aug 2009 – Suffolk Mental Health Partnership (SMHP) had 5 deaths (9 deaths in under 2 years) and the death of a 19 year old on Southgate Ward – Bury St Edmunds. • July 2009 – Norfolk and Waveney Mental Health Foundation NHS Trust (NWMH) to organise recruitment fair at Hellesdon Hospital (including on the spot interviews for clinical and non clinical roles (40). • July 2010 – SMHP agrees to start merger talks with NWMH on the basis of expected clinical benefits, opportunities for staff and economics of scale by operating as a larger Trust • Aug 2010 – Rae report, “SMHP has management issues, poor leadership and badly maintained records – pressing clinical quality and safety issues, lack of adequate action plans, and no proper complaints procedure (too many action plans – confusing and not audited/followed through). • Nov 2010 – The strategic Health Authority's full body to study business case for the merger talks in January 2011. NWMH C.E.O. Aidan Thomas, “The trust was asked to take over management of SMHP by NHS East of England Strategic Health Authority, as a result of serious safety concerns.....need to ensure improvement of services”. • March 2011 – Mark Halladay SMHP C.E.O to leave end of March and Aidan Thomas appointed interim C.E.O and overall C.E.O of the merged trusts later in the year. • January 2012 – The merger is confirmed (NWMH+SMHP=NSFT) new trust is now called Norfolk and Suffolk Foundation Trust. • Oct 2012 – Bob Blizzard (ex Labour party MP for Waveney), “concerns raised about proposed cuts to mental health beds in Norfolk and Suffolk – bed cuts could be reduced from 42 to 20.....patients were already being sent to out of area acute placements, e.g. Basildon, Cambridge and Hackney at average £500 per day”. Reason for bed cuts – service shifting to care in the community but community teams had been cut from 2 to 1 (staff number was halved). NSFT spokesperson, “current situation would not support a bed reduction. However we require early intervention, robust Personality Disorder strategy, reduced multiple assessment, speed up social care support – real alternatives to hospital admissions....won't close any beds until there's evidence beds are no longer needed plus early intervention is working. • Nov 2012 – NSFT present plans for a new mental health services structure in Norfolk and Suffolk. Service redesign – to change the way people with depression and dementia access to receive care. Plans drawn up by clinical leaders – provide increased quality and responsive services, new access and assessment service covering 2 counties and division of Norfolk = 3 service areas based on Great Yarmouth, Waveney, and West Norfolk and Central Norfolk....New roles and responsibilities discussed. • Jan 2013 – British Medical Association (BMA), “NSFT plans to cut number of doctors by over a third could put services at risk”....up to 500 staff including 49 Doctors, the plan is to save £40m and £700 was spent on buying chocolates to celebrate the merger of the 2 trusts. The trust planned a budget reduction over 4 years through a package of cuts. Dr Rob Harwood (BMA's Eastern secretary), “33 consultants (a third of the total number) + 16 Doctors (40% of the total) to be lost.....will be less easy to access mental health services in the region. Dr Hadrian Ball (NSFT Medical Director), “service strategy out for consultation and strategy designed to allow trust as NHS provider to deliver services
  2. 2. without anticipating any major increase in funding over the next 3-4 years and such a strategy involves significant change to the workforce. • June 2013 – Dr Harwood (BMA), “resignation of C.E.O will provide an opportunity to rethink in advisable cuts”. • July 2013 – Aidan Thomas (NSFT, C.E.O) announces resignation, “I do believe my style of management is better suited to a smaller organisation- considered resignation after merger but stayed to support new chair and complete the Trust service Strategy Consultation”. Once Consultant commented, “C.E.O stepping down at a point when a major service redesign goes live.....there are concerns among clinicians about how the change will work”. Another comment read, “centrepiece of so-called redesign, Access and Assessment Team is an utter failure, with huge backlogs, breached deadlines, massively over-budget with additional staff drafted to try to pull the wool over GPS, but Trust pretends its a success. Why have the chair, C.E.O and director of Nursing and Governance all decided to leave”? • 3 Oct 2013 – NSFT lost £3m mainly to redundancy costs. • 9 Nov 2013 – 79 mental health workers made redundant in Norfolk and Suffolk as part of the £40m cost savings are to be invited to apply for jobs following a Trust review (29 more are set to leave on 1 Dec 2013). Andrew Hopkins now interim C.E.O, “been keeping strategy under review – reduce redundancies and keep staff working in mental health services”. • 20 Nov 2013 – whistleblower nurse of 15 years experience comments, “if something awful happens on your shift, we don't feel well supported, we feel we'll be the scapegoat and the Trust will blame individual staff.....and there is low morale among staff”. Bob Blizzard, “No C.E.O since Thomas' departure, nobody wants to lead, the Trust is in chaos and I fear a meltdown”. • 10 Dec 2013 – Some patients are being offered beds that are hundreds of miles away from home, e.g. Scotland. Income is 1.3% lower this year will be around 2% lower in each of the next 2 years and costs will increase by 3% per annum. NSFT chairman, “the Trust is not in crisis”. • 28 Jan 2014 – Norfolk County Council to resume control, in September 2014, of social care for adults with mental health issues after NSFT which runs the service criticised for poor performance. • 19 Feb 2015 - The Care Quality Commission (CQC) report on Hellesdon Hospital said improvements were needed. It said patients' needs were "not always assessed in a timely way" and many care plans were out of date. The Norfolk and Suffolk NHS Foundation Trust, which runs the hospital, said it was addressing concerns. The CQC also found that risk assessments were often incomplete, and that one patient inspectors talked to did not know he had been detained under the Mental Health Act. The report said that some patients were admitted for longer than required or placed on wards that provide "care and treatment at a higher level than they required". The CQC also highlighted examples of excellent care at the hospital and said it met national standards in dealing with complaints, safeguarding people from abuse and in working with other health care providers. CONCLUSION Based on the turn of events in this timeline, it can be concluded that: 1. SMHP had major management issues (as highlighted in the Rae Report of 2010) which had serious impact on their clinical outcomes and NWMH appears to have been the opposite of what was happening at SMHP hence the Strategic Health Authority's recommendation for the 2 Trusts to merge into 1 large Trust under 1 C.E.O. 2. While there is no news report on the priorities of the new C.E.O, it would have been expected that the new C.E.O would have put the issues raised in the Rae Report high on his priority list.
  3. 3. 3. It is also reasonable to assume that a new Service Redesign was also high on the priority list and there was also the added pressure of the economic situation at the time and the subsequent budget pressures to reduce costs. The Trusts merged early 2012 and by the end of the year anxiety was already high with regards to the proposed cuts which were yet to be made public. 4. The new service plans were presented in November 2012 and as soon as the new plans went live, in July 2013, the C.E.O resigned because “his style of management was more suited to a smaller organisation”. 5. It can be assumed that the Service Redesign plan may have been very challenging for those involved in its initiation, the challenges faced may have had a serious impact on the finalised Service Redesign plan and from November 2013, the implementation of the new plan was already costing the Trust money instead of saving money, as planned; and this had an impact on the clinical outcomes. 6. It was reported that the Trust failed to act on 258 recommendations from 98 reviews into Serious Untoward Incidents such as patient deaths and the coroner commented, “staff needed to learn lessons to reduce risks. The failings in the CQC report, of February 2015, point in the direction of demoralised staff and the subsequent poor implementation of standard clinical governance procedures, e.g. clinical audits, clinical risk assessments, the nursing process (assessment, planning, implementation and review of care. 7. Nursing staff appear to have been working 'to cover their backs' and this is reflected in the report's highlight of 'excellent care in Safeguarding patients from abuse, handling of patients' complaints and when working with other health providers'. 8. It is fair to point out that it is also reported that ' of all the healthcare providers in the region , except NSFT, had increased funding since 2010, yet mental health service budgets were being cut'. NSFT had become a much larger trust and this may also have contributed to the some of the challenges faced by the trust management and the subsequent pressures on staff. 9. Based on the findings above, it would be reasonable to recommend a review of the Service Redesign plan. 10. This draft report is based on the bigger picture of what was happening across the whole service. However, more nursing floor information/data would be required for detailed individual service area/ward reports of the affected areas of care.